| NPI | 1144209701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 1256801) |
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology (Licence: NY 1256801) |
| 207ZP0101X Pathology, Anatomic Pathology (Licence: NY 1256801) | |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2014-05-19 |